RESUMO
Health-related quality of life (HRQL) is currently essential in the evaluation of stroke-related clinical trials. Existing stroke-specific scales were developed in English-speaking countries and most of them do not satisfy the necessary standards of validity. In consequence, the first Spanish-language scale for evaluating the quality of life (QL) of stroke survivors was developed (ECVI-38). In this work the psychometric properties of this summary measure were assessed. A group of 63 stroke patients were studied, between 2 months and 2 years after the event, to evaluate the acceptability, reliability and validity of the ECVI-38, using standardised psychometric methods. The ECVI-38 proved to have an important degree of acceptability; only three elements showed a high percentage of data loss due to the age of the patients in the sample; the floor and ceiling effects were within the accepted limits. The scale displayed good internalconsistency (Cronbachs á 0.79-0.97, correlations between elements 0.53-0.90) and good stability in the test-retest trial (intraclass correlation coefficients 0.89-0.98). As regards its construct validity (total correlations among correct domains, convergentr = 0.57-0.90, discriminating r = 0.19-0.39), the results were very good, as were the findings of the studies of validity vs. external criteria (difference between groups with a known neurological status, and convergence validity). The ECVI-38 isa measure that is acceptable, reliable and valid for evaluating QL in patients who have had a stroke. Further tests are needed to evaluate its sensitivity and to explore its value in both clinical and research practice. [REV NEUROL 2005; 41: 391-8] Key words. Psychometric properties. Quality of life scale. Stroke. Summary measure(AU)
La calidad de vida relacionada con la salud (CVRS) actualmente es clave en la evaluación de ensayos clínicos para el ictus. Las escalas ictusespecíficas existentes se desarrollaron en países anglosajones y la mayoría no reúnen los requisitos de validez necesarios. Por ello, se desarrolló la primera escala hispana para evaluar calidad de vida (CV) en sobrevivientes a un ictus (ECVI-38). En este trabajo se evaluaron las propiedades psicométricas de esta medida resumen. Se estudiaron 63 pacientes con ictus, entre 2 meses y 2 años de su ocurrencia, para evaluar la aceptabilidad, fiabilidad y la validez de la ECVI-38, con la utilización de métodos psicométricos estandarizados. La ECVI-38 demostró buena aceptabilidad; solamente tres elementos tuvieron alto porcentaje de datos perdidos debido a la edad de los pacientes de la muestra; los efectos piso y techo estuvieron dentro de los límites aceptados. La escala mostró buena consistencia interna (a de Cronbach 0,79-0,97, correlaciones interelemento 0,53-0,90) y buena estabilidad en la prueba test-retest (coeficientes de correlación intraclase 0,89-0,98). En cuanto a su validez de construcción (correlaciones totales entre dominios correctas, r = 0,57-0,90 convergente, r = 0,19-0,39 discriminante), sus resultados fueron muy buenos; así como los estudios de validez contra criterio externo (diferencia entre grupos con estado neurológico conocido, y validez de convergencia). La ECVI-38 es una medida aceptable, fiable y válida para la evaluación de la CV en pacientes que sufrieron un ictus. Se necesitan nuevas pruebas para evaluar su sensibilidad e investigar su utilidad en la práctica clínica e investigadora(AU)
Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Qualidade de Vida , Inquéritos e Questionários , Acidente Vascular Cerebral/fisiopatologia , Acidente Vascular Cerebral/psicologia , Testes Neuropsicológicos , Avaliação de Resultados em Cuidados de Saúde , Reprodutibilidade dos Testes , Perfil de Impacto da Doença , Estatística como Assunto , Sobreviventes , Atividades Cotidianas , Avaliação da Deficiência , Seguimentos , IdiomaRESUMO
INTRODUCTION AND AIMS: Health-related quality of life (HRQL) is currently essential in the evaluation of stroke-related clinical trials. Existing stroke-specific scales were developed in English-speaking countries and most of them do not satisfy the necessary standards of validity. In consequence, the first Spanish-language scale for evaluating the quality of life (QL) of stroke survivors was developed (ECVI-38). In this work the psychometric properties of this summary measure were assessed. PATIENTS AND METHODS: A group of 63 stroke patients were studied, between 2 months and 2 years after the event, to evaluate the acceptability, reliability and validity of the ECVI-38, using standardised psychometric methods. RESULTS: The ECVI-38 proved to have an important degree of acceptability; only three elements showed a high percentage of data loss due to the age of the patients in the sample; the floor and ceiling effects were within the accepted limits. The scale displayed good internal consistency (Cronbach's alpha 0.79-0.97, correlations between elements 0.53-0.90) and good stability in the test-retest trial (intraclass correlation coefficients 0.89-0.98). As regards its construct validity (total correlations among correct domains, convergent r = 0.57-0.90, discriminating r = 0.19-0.39), the results were very good, as were the findings of the studies of validity vs. external criteria (difference between groups with a known neurological status, and convergence validity). CONCLUSIONS: The ECVI-38 is a measure that is acceptable, reliable and valid for evaluating QL in patients who have had a stroke. Further tests are needed to evaluate its sensitivity and to explore its value in both clinical and research practice.
Assuntos
Qualidade de Vida , Acidente Vascular Cerebral , Inquéritos e Questionários , Atividades Cotidianas , Adulto , Idoso , Avaliação da Deficiência , Feminino , Seguimentos , Humanos , Idioma , Masculino , Pessoa de Meia-Idade , Testes Neuropsicológicos , Avaliação de Resultados em Cuidados de Saúde , Reprodutibilidade dos Testes , Perfil de Impacto da Doença , Estatística como Assunto , Acidente Vascular Cerebral/fisiopatologia , Acidente Vascular Cerebral/psicologia , SobreviventesRESUMO
INTRODUCTION: The selection of a measure that can be used to evaluate the outcome of therapeutic interventions in stroke patients has had a conceptual problem in that there is a need to detect a wide range of deficiencies, disabilities and handicaps as part of a patient-based model. It has also suffered from a methodological problem due to the lack of systematic attention given to the development of standard instruments. AIMS: We conducted this study with the aim of getting over these limitations by developing a scale to evaluate the quality of life in stroke survivors. SUBJECTS AND METHODS: We followed a methodology that had previously been standardised by other authors based on using the opinion given by patients and caregivers in the generation of the items to be included. This has several stages that include individual interviews with patients, caregivers and experts, focal groups with patients and experts, quantitative and qualitative analyses of these interviews, two panels of experts to actually draw up the instrument, and a pilot test carried out in a sample of 50 patients to reduce and group the items. This reducing and grouping process was performed taking into account the following: 1. The percentage of responses left unanswered; 2. A factorial analysis of the main components; 3. Cronbach's alpha coefficient. RESULTS: We interviewed 20 patients and 12 experts; these results were later used to classify the above mentioned aspects in order of priority according to the frequency with which they appeared in the surveys. Then, we elaborated the questionnaire with four areas or subscales by including the questions or items in these categories: I. Physical status (17 items); II. Emotional status (13 items); III. Activities of daily living (13 items); IV. Social and familial functions (13 items). After the pilot study 38 items were reorganised into eight domains, according to the factorial analysis: 1. Physical problems; 2. Communication; 3. Cognition; 4. Emotions; 5. Feelings; 6. Activities of daily living; 7. Familial functions; 8. Social functions. They displayed high coefficients of internal consistency. CONCLUSIONS: We developed a new scale for evaluating the quality of life for stroke patients and it is now ready to undergo its validation process.
Assuntos
Qualidade de Vida , Acidente Vascular Cerebral , Inquéritos e Questionários , Atividades Cotidianas , Pessoas com Deficiência , Humanos , Reprodutibilidade dos Testes , Perfil de Impacto da Doença , Acidente Vascular Cerebral/patologia , Acidente Vascular Cerebral/fisiopatologia , Acidente Vascular Cerebral/terapia , SobreviventesRESUMO
The selection of a measure that can be used to evaluate the outcome of therapeutic interventions in stroke patients has had a conceptual problem in that there is a need to detect a wide range of deficiencies, disabilities and handicaps as part of a patient-based model. It has also suffered from a methodological problem due to the lack of systematic attention given to the development of standard instruments. AIMS: We conducted this study with the aim of getting over these limitations by developing a scale to evaluate the quality of life in stroke survivors. We followed a methodology that had previously been standardised by other authors based on using the opinion given by patients and caregivers in the generation of the items to be included. This has several stages that include individual interviews with patients, caregivers and experts, focal groups with patients and experts, quantitative and qualitative analyses of these interviews, two panels of experts to actually draw up the instrument, and a pilot test carried out in a sample of 50 patients to reduce and group the items. This reducing and grouping process was performed taking into account the following...(AU)